Anjanette Tan, MD

Anjanette Tan, MD Endocrinology, Diabetes, and Metabolism

05/26/2026

What scares me about GLP-1s in type 1 diabetes isn't the medication. It's starting without a plan.

In the ADJUST-T1D trial, total daily insulin dropped 18% by week 4 — at the lowest starting dose of 0.25 mg. Bolus insulin dropped 23%. And 83% of that reduction was a direct drug effect, not weight loss.

The drop comes before the scale moves.
You don't wait to adjust. You adjust at initiation — proactively reducing bolus settings by 20–30%.The trials give us this roadmap.

This week I'm walking through what they found.
Save this series if you or someone you love has type 1 diabetes.💙

05/23/2026

My mentors always encouraged me to teach. ⁣
And this is where teaching now occurs.⁣
I present what is on my mind.⁣
I post what I wish I had more time to tell my patients.⁣
Thank you for all the follows and comments. 💬⁣
Thank you for the messages. ✉️⁣🫶🏼
⁣

05/22/2026

Osteoporosis has no symptoms. This is not reassurance — it is the clinical reality that makes it so dangerous.Bones do not hurt until they fracture.

There is no ache, no warning signal, no gradual discomfort to alert you. By the time pain arrives, the fracture has already occurred.

What to watch for instead: 🚨
height loss of more than 1.5 inches from your peak adult height, unexplained early satiety or reduced appetite, or a persistent mid-back ache that improves lying down.

These are not symptoms of osteoporosis. They are symptoms of fractures that may have already happened silently. Get your height measured at every visit.
Ask what the number means.

When was the last time a doctor measured your standing height? Drop ✅ if recently or ❌ if you honestly cannot remember.

FRAX is the most widely validated fracture risk calculator in the world. It is also incomplete in specific ways that mat...
05/21/2026

FRAX is the most widely validated fracture risk calculator in the world. It is also incomplete in specific ways that matter for people with type 2 diabetes, those on long-term steroids, people with thyroid disease, and those with hyperparathyroidism.

FRAX does not include falls, does not distinguish recent from remote fractures, and does not include diabetes as a variable — despite 40 to 70% higher fracture risk in T2D patients relative to their bone density.Knowing what your calculator includes — and what it misses — is part of understanding your actual risk.

Save and Share this to friends and family, early evaluation can change your whole approach.📋📌

05/20/2026

Secondary osteoporosis — bone loss from a medical condition or medication — is common, often missed, and sometimes causes fractures before standard imaging flags a problem.

Glucocorticoids, aromatase inhibitors, androgen deprivation therapy, anticonvulsants, excess thyroid hormone, long-term PPI use, and depot medroxyprogesterone are all associated with bone loss through documented mechanisms.

If any of these are part of your medical history, ask your doctor whether your bone health has been evaluated in that context specifically.

Which of these did you not know was associated with bone loss? Drop it in the comments.🦴💬

Your DEXA report gives you a T-score. Your T-score tells you where your bone density sits relative to a young adult refe...
05/19/2026

Your DEXA report gives you a T-score. Your T-score tells you where your bone density sits relative to a young adult reference population.

What it does not tell you is your complete fracture risk.Bone quality, prior fracture history, medication list, age, fall risk, and certain medical conditions all contribute to fracture risk independently of what the scan shows.

A normal result is important information. It is not a guarantee.
Swipe through for the breakdown. 👆🏻

Save this and share it with someone navigating a bone density result.

05/18/2026

Seventy percent of osteoporotic fractures occur in people whose bone density does not meet the threshold for osteoporosis. This is one of the most important and least communicated facts in bone health.

A DEXA scan is the beginning of the fracture risk conversation — not the end. Bone density is one input. Age, fall history, prior fractures, medication list, diabetes status, and bone quality are others — and some of them carry more predictive weight than the T-score alone.

This week on Quiet Health: what your bones are actually telling you.

Drop a ❓ if you have had a DEXA scan and a ❓❓ if you have never had one. I want to know where my audience is starting from.💭

05/15/2026

Before I write a prescription for high triglycerides, I go through this list with every single patient.

Cut the added sugar and refined carbs → minimize alcohol → 150 min aerobic exercise weekly → resistance training 2x/week → 5-10% weight loss → fatty fish 2x/week.

Highly motivated patients doing all of this? More than 70% reduction in triglycerides from lifestyle alone. That's not a rounding error. That's the intervention.

Save this if you've been told your triglycerides are high.🚨

Highly motivated patients who change their diet and lifestyle? More than 70% reduction in triglycerides — before a singl...
05/14/2026

Highly motivated patients who change their diet and lifestyle? More than 70% reduction in triglycerides — before a single medication.

Swipe through for the exact framework I walk through with every patient who comes in with elevated triglycerides. This isn't generic wellness advice. It's what the data actually supports.

Did you know sugar was connected to your triglyceride levels? Drop a comment — I'd love to know what landed for you.💬

05/13/2026

Most people with high triglycerides have already cut the fat. Nobody told them to look at the sugar. 🍩

Your liver converts excess sugar and refined carbs into triglycerides — and releases them into your bloodstream. This is why your "healthy" granola bar might be driving your lab values up.

If no one has walked you through what's actually behind your numbers, that conversation deserves to happen.

Save this. Share it with someone who needs it.⬇️
Follow for more of the real stuff.🔬
Drop a 💾 if you're saving this for later.

Your triglycerides aren't high because of fat. For most people, it's the sugar.Swipe through to understand exactly what'...
05/12/2026

Your triglycerides aren't high because of fat. For most people, it's the sugar.

Swipe through to understand exactly what's driving your numbers — and what to do about it. This is the breakdown I give my patients before we even talk about medication.

Save this for your next lab conversation.
Share with someone whose labs came back flagged.📌
Drop your questions below.💬

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6844 Harris Parkway
Fort Worth, TX
76132

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+18172630007

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